Provider Demographics
NPI:1003662719
Name:PARKS, JERI
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:PARKS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 GILBERT RD S
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WA
Mailing Address - Zip Code:98570-9400
Mailing Address - Country:US
Mailing Address - Phone:425-224-5096
Mailing Address - Fax:
Practice Address - Street 1:140 GILBERT RD S
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WA
Practice Address - Zip Code:98570-9400
Practice Address - Country:US
Practice Address - Phone:425-224-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health